Beach

The past couple of days I've been leaving hospital at lunch time, going back to the residence for lunch and walking to Nyali beach. The beach has beautiful white sand, is lined by coconut trees and has warm turquoise water. There's usually a good breeze so it's popular for water-sports. There's a water-sports centre on the beach which offers windsurfing, jet skiing and kitesurfing. I learned how to windsurf with a few friends which was really awesome- such good fun. I can now stand up, windsurf my way out to sea, turn the board and come back. It's been pretty hot the past couple of days and I've got sunburned each time with factor 50 spf suncream on!

Obs ang Gynae

I "sat-in" to the Gynae outpatient clinic  having been told by the staff that I would see the wide range of typical cases seen here. Patients often present in the late stages due in part to an absence of surveillance. For example, cervical smears are largely performed when it is perceived that there is a gynae problem. From my day there, the clinic routinely deals with fibroids, cancer (cervical, ovarian), dysmenorrhoea, postmenopausal bleeding, genital prolapse, complications of surgery.The experience has given me a different perspective of gynaecology and highlighted the importance of screening.
I  also followed a doctor on the labour ward and had the opportunity to practise  history taking, clerking in a patient, obstetric examination, taking blood. The foetal stethoscope is used to check the foetal heart rate and foetal distress when ultrasound and sonicaid are not available. "It" went missing today to the anger of the doctor in charge who insisted that there should be one per bed. A different approach to pain is taken and laboring women are not routinely given analgesia (some are given i.m pethidine).

End of paediatrics

I've spent this week on the paediatric ward. I got to take histories, do examinations, partake in ward rounds, shadow the junior doctor, take blood, help request and deliver blood transfusion products and play with lots of kids! The main medical conditions that i encountered were meningitis, pneumonia (no bronchiolitis), HIV, malaria, febrile convulsions, burkitt's lymphoma. The ward was better equipped and staffed than i thought it would be (sufficient gloves, analytical equipment and medicines) and is a great place for learning as doctors are happy to answer any questions you may have and supervise you during procedures. I'm looking forward to Obs & Gynae next week!

Back from safari

The safari was awesome!Awesome except for the 28 hours of cramped bumpy road travel to and from the Maasai Mara. I got to see a herd of wild elephants which was at the top of my list. I also saw lions eating zebra, zebra (avoiding lions) cheetahs, wildebeest, smelly, charging human hating hippos, wild dogs and mischievous baboons.
We also met the Maasai people, had a tour of their houses and had a brief jumping competition/dance with them. They live in cow pat houses and drink cow blood, they are a really amazing people! The best aspect of their lives seemed to me their closeness to nature and their impressive athleticism, ingenuity and hunting skills. I'll never forget their hospitality and good will. I'm really glad I went, had a great time!

Safari details

We're leaving with a group of ElectiveAfrica leaders tomorrow morning for Nairobi. We'll be staying the night there in a hotel, then head for the Maasai Mara where we'll go on safari. I'd love to meet a few of the local Maasai people, and see as much of the wildlife as i can (elephant, lion, buffalo, hippo, crocodile,rhino). ElectiveAfrica are organising all our food, drink, accommodation and facilities while on safari. Should be a trip to remember! Can't wait!!

Last day in Coast Province General Hospital before Safari!

I went into hospital today wanting to learn more about HIV given that I have met so many patients on the General medicine ward who have the virus. I went the the HIV clinic and was talked through the diagnosis and management of HIV at Coast Province General Hospital. The staff use a sensitive test to screen for HIV and a specific test to confirm the positive result. Both tests involve a reagent strip on which a drop of capillary blood from the patients finger is placed.
The World Health Organisation (WHO) funds a lot of the resources for managing HIV including anti-retroviral medicines (lamivudine and zidovudine are the first choice medicines). The clinic also distributes condoms to it's patients and encourages contact tracing (testing those who have had sexual contact with an person with HIV). The hospital monitors the CD4 count of it's HIV patients and again this is funded by the WHO. There is much stigma and fear attached to being seropositive for HIV. I was informed by the doctor that a child who is HIV positive from birth (having picked up the virus from the mother) can be expected to live into his or her twenties. The burden of HIV is immense here and the staff in the hospital do a great job in their clinics in helping patients with HIV live as long and healthy a life as possible.

Self-guided tour around Coast Province General Hospital

I went into hospital for 9am this morning, getting a lift from our regular taxi driver. The traffic in the morning is really hectic heading towards the island of Mombassa so I'm really glad ElectiveAfrica has organised our journey to and from hospital. I met the other medical students on the general medicine ward round, then decided to explore the hospital a bit on my own. First I went to ophthalmology and after a chat with the nurse there i was introduced to some of the conditions the patients there suffer from, a lot of cataracts, diabetic and hypertensive retinopathy. I continued on my tour and cane across the dialysis unit. It was quite small but very clean and well equipped. I took a history from a regular patient who requires dialysis because of hypertension-associated chronic renal failure. The effect of his illness interfered a lot with his work but he seemed used to getting dialysis and was happy to take me through his story.
Next I decided to call into paediatrics, which was the most enjoyable part of my day. I introduced myself to one father and asked if the little girl on the bed he was sitting on was his daughter. There were two children on the bed, one was his son and the other was the daughter of another woman who had momentarily left the bed. On one bed a examined a child with meningitis, on the next bed a child with sickle cell anaemia (a congenital blood disorder) and on the next bed a child with rheumatic heart disease. I discovered that the child with SSD, also had malaria, had a heamoglobin of 2g/dl (very, very low!) and needed an urgent blood transfusion. The child with meningitis had headache, fever and had experienced convulsions. The child with rheumatic fever had an audible heart murmur. I assisted the doctor on the ward round by helping to take the blood samples for analysis.
Lastly I went to the General Medicine clinic and met a lead consultant. One patient had metabolic syndrome. I have to admit that i didn't expect to see much of this in Kenya because it's mainly a disorder of people in Western nations who lead an unhealthy lifestyle. The doctor explained that people in kenya are eating more unhealthy foods now and suffer more and more form high blood pressure, diabetes and  high cholesterol. The patient in question really liked putting salt on everything she eats! The doctor advised her to change her ways and referred her to various specialists such as the nutritionist.
I got out of hospital at 1pm and cane back to the house for some lunch and internet!